New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/9/2024 3:46:00 PM
Cost:
60
Service:
Frame + Lenses
prescribed by doctor:
Dr. Hassan Damraji
Notes:
Airlite + Transition + AntiBlue
SPH
CYL
AX
ADD
OD
2
-1.5
180
OS
2
-1.25
170
Date of visit:
6/22/2024 6:19:00 PM
Cost:
40
Service:
Change Lenses
prescribed by doctor:
Dr. Hassan Dormaji
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
2
-1.5
180
OS
2
-1.25
170
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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